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    • br The west African outbreak of Ebola virus disease

    2019-05-23


    The 2014–15 west African outbreak of Ebola virus disease is unprecedented in scale, especially in Sierra Leone, which as of May 15, 2015, had reported 8598 confirmed cases and 3538 confirmed Ebola-related deaths. Sierra Leone\'s response to this emergency has been compromised by a fragile health system with scant resources, limited infrastructure, and one of the world\'s severest shortages of health-care workers, tragically compounded by the deaths of 221 health-care workers from Ebola virus disease since the outbreak began. Despite support from donors and partner organisations, Ebola treatment units were able to provide only 60% of necessary treatment beds as the outbreak neared its peak in November, 2014. Limited access to treatment centres forced individuals with suspected Ebola virus disease to remain in the 7 8-dihydroxyflavone and for families to care for such individuals at home, putting caregivers and household members at high risk of infection. Facing the gravity of the outbreak and the scarce resources at hand, the Government of Sierra Leone developed innovative but untested approaches to confront the Ebola threat. One such model was the development of community care centres. Based on experience in Liberia, these centres were designed to enable rapid isolation and palliative care for people with suspected Ebola virus disease pending availability of beds in Ebola treatment units, thus reducing household exposure and community transmission. In view of the scale of the outbreak, the promise of this approach, and the lack of alternatives, the model was launched in November, 2014, with support from the UK Department for International Development and implementing partners.
    Further attempts were made last month to initiate peace talks in the Syrian conflict, and in the context of the devastated economic, social, and health systems, such a political solution aimed at halting all fighting must be given priority over blaming one side or the other. There is evidence to suggest that a revival of basic health services can act as a trigger to bring together warring sides. As Syrian public health doctors and advisers who once helped establish one of the best national health systems in the region, we do not find it difficult to understand concerns about failures of the humanitarian aid systems in Syria, as frequently suggested in and elsewhere. However, Syria is rapidly descending into hell, Iraq-style, and the global health community needs to wake up to the implications of this reality. The economic losses of the country at the end of 2014 stood at US$143·8 billion, with more than 80% of the population living in poverty, of whom a third (32·6%) were in abject poverty, unable to obtain even basic food items. More than half of the population (52·8%) is displaced, of whom a third are internally displaced. Life expectancy has been reduced from 75·9 years in 2010 (one of the highest in the region for countries not part of the Gulf Cooperation Council) to 55·7 years in 2014—a loss of 20 years. The unemployment rate rose from 15% in 2011 to 55·7% in 2014, with more than 3 million losing work within the first 2 years of the conflict. The cost of basic food items has risen six-fold since 2010, although it varies regionally. With the exception of drugs for cancer and diabetes, Syria was 95% self-sufficient in terms of drug production before the war. This has virtually collapsed as have many hospitals and primary health-care centres. Economic sanctions have not removed the President: as with other countries under siege, in the region and elsewhere, only civilians are in the line of fire, attested to by the dire state of household and macroeconomies. Sanctions are among the biggest causes of suffering for the people of Syria and a major factor perpetuating the conflict, and our predictions of a warlord economy of plunder has already taken hold as unemployed young people among others are opportunistically recruited to fight for Jihadist groups, now mainly ISIS, destroying infrastructure for economic and political gain.